Egg quality, how it affects fertility and how it can be improved
It’s a sad fact, but the older a woman gets, their ovarian reserve declines and they have less eggs.
And unfortunately, the same happens to egg quality, which is just as, if not more important than the quantity.
Egg quality refers to whether eggs are genetically normal (euploid) or abnormal (aneuploid).
As women, we are born with all the eggs we’ll have in our whole life (around 1 or 2 million), and every month one of them gets ready to ovulate. Once the egg is selected for ovulation, it starts to mature.
As our eggs get older, they’re more likely to have errors in this process and end up containing abnormal DNA, which prevents the egg from doing its job: making a healthy baby.
Why is egg quality important for fertility?
An IVF cycle can be unsuccessful even with a good number of eggs (and embryos) if the egg quality is poor as embryos from low-quality eggs often fail to develop properly.
Therefore, higher quality eggs means that your eggs are more likely to be fertilised, develop into an embryo, implant and result in pregnancy.
Healthy eggs are essential for fertility, as they are responsible for providing the genetic material needed for the development of the embryo.
A chromosomally abnormal egg will sometimes not fertilise, or if it is fertilised, it can lead to an abnormal embryo and therefore, either not implant, sadly end in a miscarriage, or an unhealthy baby.
“Good egg quality” is therefore associated with increased fertilisation rates, improved embryo quality, and a higher chance of successful implantation.
Are there any tests that assess egg quality?
Unfortunately, no. Tests such as the AMH blood test, are useful to understand ovarian reserve (egg count), but no tests are available to identify egg quality.
However, we do know that their quality decreases with age, so that is the only ‘marker’ to ‘predict’ a patient’s egg quality. For example; a 20-year old woman, will have fewer low-quality eggs, and conversely, an older 40+ woman will have more eggs with abnormal DNA.
What affects low egg quality?
Since egg quality plays a key role in fertility, it’s important to know the signs that may indicate poor egg quality.
Some of these may include:
An abnormal number of chromosomes
Low FSH reserves
Low levels of oestradiol
Low levels of anti-mullerian hormone (AMH)
Low Follicle Count
Irregular period cycle and difficulty conceiving
The link between chromosomal disorders and egg quality
Chromosomal disorders, or an abnormal chromosome number may be one of the signs of poor egg quality.
Usually, an egg has 23 chromosomes. When it is fertilised by a sperm (which also has 23 chromosomes), the embryo that is formed will have 46 chromosomes – the normal amount.
When egg quality is normal, it means the chromosomes are normal.
If eggs are abnormal or of poor quality, the number of chromosomes will be less than or more than the normal number. These eggs are called aneuploid eggs.
If conception occurs with this egg, the embryo that forms will have an abnormal number of chromosomes.
FSH and poor egg quality
Low reserves of Follicle Stimulating Hormone (FSH) can indicate that the eggs are decreasing in quality.
FSH is the hormone secreted by the pituitary gland, which signals the ovaries to make an egg every cycle.
As the egg quality reduces, they become more resistant to FSH, and it requires more FSH.
This leads to higher levels of FSH in the body (and low FSH reserves), which is one of the signs of poor egg quality.
Oestrogen and poor egg quality
Low levels of estradiol can also be one of the signs of poor egg quality.
Estradiol is the primary form of estrogen in your body during your reproductive years. It’s the most potent form of estrogen hormone that communicates signals from the ovaries to the brain.
When estradiol levels increase, the ovarian follicles are stimulated to grow. If the estradiol levels are high at an early stage of the cycle, it can indicate that the ovaries are releasing it early and that the egg quality is reduced.
Low follicle count and poor egg quality
A low follicle count can be determined by transvaginal ultrasound, in which the follicle count is assessed by counting the number of follicles between four and nine millimetres in the ovaries.
A lower number of follicles could indicate problems with egg quality and quantity.
Does AMH affect egg quality?
Perhaps the biggest indicator of low egg equality, are low AMH levels.
AMH is a glycoprotein that is released by the cells of eggs in their initial stage of development. It stimulates the eggs to mature and helps develop them.
A low AMH means poor reserve, but generally, quality is not compromised if you are younger than 35.
Multiple miscarriages: a sign of poor egg quality?
Having multiple miscarriages may indicate that the eggs being produced are aneuploid or abnormal.
Multiple factors may lead to a miscarriage. However, multiple miscarriages may be a strong indication of an underlying issue with egg quality.
If conception occurs with an abnormal egg, the embryo that forms will have an abnormal number of chromosomes, and while such foetuses are usually prevented from implanting in the uterus, abnormal eggs may still implant. In cases like that, it may sadly result in a miscarriage.
Age and egg quality
There are several things that can help your egg quality, but there are some things that can’t be changed.
Age is one factor linked to poorer egg quality when patients experience a lower chance of fertilisation and implantation, and a higher chance of miscarriage, but that doesn’t mean to say pregnancy can’t happen in a woman who is a little bit older.
How can I improve egg quality?
While there is nothing you can do to prevent the regular loss of eggs as you age, there are several fertility supplements you can take along with dietary and lifestyle changes that you can make to improve your egg quality, and hopefully improve your chances of pregnancy.
Generally, a healthy lifestyle is very important; avoiding smoking, limiting caffeine consumption and exercising.
Eggs take approximately 90 days to develop through to ovulation, therefore we recommend making any lifestyle changes, including taking supplements, starting acupuncture, and making diet changes, around three to four months before trying to conceive.
How can DHEA help egg quality?
There is some research that DHEA and Coenzyme Q10 can help with egg quality – mostly focused on women undergoing IVF.
DHEA (dehydroepiandrosterone) is a natural steroid hormone, which is present during a woman’s reproductive years. It has been used as a supplement since 2004, especially in women with poor ovarian reserve.
Some studies have shown that DHEA supplementation could improve the quality of eggs and embryos, increase pregnancy rates, and reduce miscarriages rates.
Always consult a doctor before taking any kind of supplement relating to your fertility.
How can Coenzyme Q10 help egg quality?
Coenzyme Q10 has also been studied as a supplement for women with poor ovarian reserve and quality. It is a fat-soluble coenzyme present in the mitochondria, which are responsible for energy production in the cells.
CoQ10 acts as an antioxidant and plays a crucial role in energy production inside the mitochondria. It has also been shown that it improves cardiovascular function and male fertility.
In female fertility, studies have been done in young patients undergoing ovarian stimulation, not in women trying to conceive naturally. In those studies, CoQ10 has increased ovarian response, egg and embryo quality. However, there is still not enough evidence to strongly recommend this product to improve egg quality.
Always consult a doctor before taking any kind of supplement relating to your fertility.
Improving egg quality with your diet
Not all foods are created equal – so think quality over quantity. Go organic, where possible, eat in season, eat food as close to nature as nature intended.
Our vitamin and minerals help boost egg quality and contain antioxidants help to protect from damage caused by toxins. This is especially important if you are older or have unexplained infertility, as studies have shown there is oxidative damage to egg health in these groups.
Eat the rainbow to help egg quality
Eating a wide range of fruits and vegetables across the colour spectrum is a sure-fire way of optimising your nutrient and antioxidant intake, allowing you to help prevent or reverse some of this damage.
Research has shown that women with higher antioxidant levels during egg freezing and IVF cycles had greater success rates. Dark leafy greens, deeper coloured fruits, vegetables (peppers, berries, beetroot), almonds, Brazil nuts, orange foods such as carrots, sweet potatoes, and butternut squash, amongst many others are especially beneficial.
Egg quality and protein
Proteins are our main building blocks of the body, allowing us to rebuild and repair. Good protein sources include: eggs, lean meat and poultry, wild caught fish, legumes pulses, nuts, seeds.
Although diet can’t repair damaged eggs, a good diet can protect healthy eggs and promote good egg quality.
How can carbs and fats help egg quality?
Complex carbohydrates provide us with energy and fibre. Healthy fats, provide energy and help to regulate hormones and are a key component of our cell membranes (the outer part of our cells), allowing them to function well.
Complex carbohydrate sources: sweet potato, brown rice, quinoa, oats, pulses, legumes, various vegetables such as carrots, broccoli, courgette, green beans, asparagus, spinach, apples, pears etc.)
Some good healthy fat sources include: olive oil, avocado, chia seeds, flax seeds, and nuts.
Folate and egg quality
Supplements such as folic acid, vitamin D and co-enzyme Q10 can also help to improve your egg quality.
Folate is a natural form of Vitamin B9. You find folate in foods, whilst folic acid is the manufactured version you find in supplements.
In addition to its well-established role in neural tube defect prevention, research suggests folate plays an important role in promoting egg quality, maturation and implantation.
Folic acid supplementation has been shown to improve the environment for the developing egg and is associated with improved chances of pregnancy and reduced risk of ovulatory infertility.
Unless your GP advises a higher dose, women trying to conceive should take a 400mcg folic acid supplement daily, whilst including folate-rich food in their diet.
You can find folate in fortified breakfast cereals, leafy green vegetables, broccoli, peas and chickpeas.
How does Omega 3 help egg quality?
Omega-3 is an essential fatty acid that has been linked to improved egg quality and delayed ovarian ageing.
Even short-term dietary treatment with omega-3 fatty acids is thought to improve egg quality, although lifelong omega-3 consumption is advised.
You can find omega-3 in supplements, but it occurs naturally in:
Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines)
Nuts and seeds (such as flaxseed, chia seeds, and walnuts)
Plant oils (such as flaxseed oil, soybean oil, and canola oil)